Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Factors Influencing Level of Stress During the Nursing Home Decision Process

This investigation examined whether characteristics of elders and their caregivers and facets of the nursing home decision-making context were associated with recalled levels of stress during nursing home decision-making. Employing a conceptual framework based upon the literature on caregiver stress and nursing home decision-making, we considered a number of factors that might influence sponsors' stress as decisions were being made about nursing home placements. We examined data from telephone interviews with a sample of 142 sponsors (responsible parties) of first-time, recently admitted nursing home residents. Higher levels of reported stress were directly associated with more factors triggering the decision to admit, higher levels of competing demands, and limited time. Employment was indirectly related to higher stress through its impact on demands. Hospitalization and being the spouse or an adult child of the resident were indirectly related to stress because they were associated with limited available time. The results offer some insights into the types of individuals who may be vulnerable to higher levels of stress and the kinds of interventions that might avert high stress in the nursing home decision process.     

国外护士道德韧性的研究进展及启示

结合既往资料,对国外护士道德韧性的概念发展、特征、测量工具、影响因素、作用进行具体综述。道德韧性的6个特征包括个人正直、关系正直、适应力、自我调节、自我管理、道德效能。护士道德韧性的影响因素包括性别、年龄、协调联系、同伴支持、道德困扰和道德勇气。研究发现道德韧性可以作为抵抗道德困境的途径、提高护士心理健康水平,以及减少职业倦怠与降低离职率。总结提出宏观层面应制定政策、提供组织支持,中观层面培养道德韧性,微观层面指出我国护士道德韧性的研究发展方向,为国内护士道德韧性的发展提供参考。

     

社区护理病房中长期慢性病患者的照料服务机制——基于质性研究的方法

现有社区护理病房照料服务存在不能充分满足患者的深层需求、生活质量不佳的问题。访谈材料显示出由于照料者缺乏对“善终”概念的认知,患者、家属以及医护人员的三方关系中,患者处于权力的弱势地位,主体之间在讨论死亡相关问题上存在严重的脱节。患者的意愿从表达、传递、实施等环节中都存在阻碍,患者“善终”的需求无法实现。“以患者为中心”的照料理念应在现有照料服务中加以推广,通过提升社区照料质量来满足医学关系、家庭关系和患者自身利益的既定政策目标。

     

癌症患者健康赋权能力的研究现状

追溯赋权的起源及其概念的演变,全面研究健康赋权的内涵及其对癌症患者的重要性。通过总结癌症患者健康赋权的测评工具、相关影响因素、促进健康赋权策略三个方面,了解国内外癌症患者健康赋权研究与实施的关键点与未来挑战,以期为探索适合我国癌症患者健康赋权的专科评估、干预模式构建和护理实践提供依据,以提高患者对健康相关知识的掌握,促使患者与医务人员共同规划、设计医疗保健行为,并最终实现以患者为中心的医疗服务理念,促进医疗系统的可持续发展。

     

Incivility at work,upset at home? Testing the cross‐level moderation effect of emotional dysregulation among female nurses from primary health care

Workplace incivility is a growing problem in nursing. However, most studies that explore this psychosocial risk and its consequences do so considering a single level and a between‐person perspective. The aims of the study were to explore whether the effects of experiencing incivility during work‐time could explain the daily levels of well‐being of nurses at home; and to analyze if that relationship could be moderated by their levels of emotional dysregulation as a trait. This is a multilevel study with diary methodology. The study was carried out in 18 primary health‐care centers belonging to Madrid and the Basque Country, in Spain. Ninety‐four nurses completed a general questionnaire and 54 of them a diary booklet over five consecutive working days in two different moments, immediately after work and at bedtime. The results showed that nurses’ emotional dysregulation moderated the relationship between daily workplace incivility and daily fatigue, and positive affect at night at home. However, there were no direct effects of daily incivility on these outcome variables. In conclusion, the presence of difficulties in emotional regulation among nurses can increase the negative effects of daily workplace incivility on their health and well‐being.     

Validation of a reflective thinking instrument for third-year undergraduate nursing students participating in high-fidelity simulation

Background: nursing students are required to think reflectively in both real and simulated clinical practice. Although the Reflective Thinking instrument is reliable in its measurement of reflective thinking, its validity is unknown. Method: confirmatory factor analysis was undertaken in an iterative manner within a non-equivalent control-group study to measure nursing students’ reflective thinking and satisfaction with high-fidelity simulation. The validity and reliability of the Reflective Thinking instrument was tested. Results: the resulting instrument consisted of 15 items across four factors. The final model was plausible as it demonstrated ‘goodness of fit’; however, it had neither convergent or discriminatory validity, nor reliability. Internal consistency was fair to reasonable for the four subscales. Conclusion: the testing of the Reflective Thinking instrument using confirmatory factor analysis is a vital initial step in the modification of this instrument. Further development using exploratory factor analysis will enhance the instrument’s relevance within high-fidelity simulation.     

Beyond you and I: role play and reflection-in-action in communication training

This article will explore the development of communication training within nurse training. Beginning by outlining current thinking around this practice, it then discusses Schön’s notion of reflective practice and its frequently cited relevance to nursing before pointing out some of its limitations. In particular, it looks at the limitations of the individual being able to critically reflect on their self within a broader social context. Drawing on the theories of Habermas and Bourdieu, it suggests that encouraging a greater awareness of one’s own social context, and hence of one’s own subject position, would develop a deeper awareness of other potential perspectives and a better ability to listen to patients. Finally, it argues for the use of role play in assisting nurses to gain such awareness, particularly in difficult clinical situations such as end-of-life care.     

癌症化疗患者护患沟通环节流程化模式初探

在癌症化疗患者的整体护理中,护患沟通较之躯体护理更具挑战性,表现为沟通难做、效果难评、学生难带、绩效难考。作者尝试一种模式,把护患沟通的各环节工作流程化、任务表格化,即首先按精心设计的流程及内容完成针对性调查,找出影响与患者沟通的有关因素及患者最为关注的问题,针对性地运用各种沟通技巧逐一沟通,实现护患沟通的个体化和差异化,同时使护患沟通环节工作有模式、效果有评价、教学有路径、考核有标准。     

护理执行用药医嘱的伦理学思考

护理人员在医疗机构推行临床合理用药的过程中承担着十分重要的任务。加强护理人员的道德教育,提高护理人员的素质,提高药物使用业务知识水平,提高与药物临床使用相关的护理技能,真正体现医疗机构推行的"以人为本"的护理理念,为患者的健康、康复负责。